American heart journal plus : cardiology research and practice · 2025
Dementia is associated with higher mortality and worse patient-centered outcomes after complex and high-risk coronary artery stenting.
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Shah Khanjan B, Xiang Lingwei, Shah Samir K, Adler Rachel R, Weissman Joel S
Аннотация
OBJECTIVES: The aims of this study were to assess whether dementia status influences outcomes of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI).
BACKGROUND: CHIP-PCI is a type of coronary artery stenting procedure for patients with anatomically complex coronary artery disease and significant medical comorbidities. As the population ages, more patients will require CHIP-PCI including those with Alzheimer's dementia and related dementias (ADRD). Outcomes of CHIP-PCI in patients with ADRD are underexplored.
METHODS: We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with and without ADRD who underwent CHIP-PCI from July 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were complications and readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care.
RESULTS: 8884 patients undergoing CHIP-PCI met study criteria, and 766 (8.6 %) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be older (81.2 vs 77.5, p < 0.001) and frail (52.1 % vs. 27.3 %, p < 0.001). 1-year mortality was higher among patients with ADRD (OR 1.34, 95 % CI 1.14-1.57) as was 90-day major complications (OR 1.22, 95 % CI 1.03-1.43) and readmissions (OR 1.27, 95 % CI 1.07-1.50). Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.81, 95 % CI 1.48-2.22) and have lower time-at-home ratios (Mean Difference -5.48, 95 % CI -9.24 to -2.45).
CONCLUSIONS: Patients with ADRD demonstrate higher 1-year mortality as well as major complications. They demonstrate especially poor time-at-home ratio and risk for discharge to a higher level of care. These data should be used by patients, their families, and physicians to facilitate goal-concordant care.
BACKGROUND: CHIP-PCI is a type of coronary artery stenting procedure for patients with anatomically complex coronary artery disease and significant medical comorbidities. As the population ages, more patients will require CHIP-PCI including those with Alzheimer's dementia and related dementias (ADRD). Outcomes of CHIP-PCI in patients with ADRD are underexplored.
METHODS: We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with and without ADRD who underwent CHIP-PCI from July 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were complications and readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care.
RESULTS: 8884 patients undergoing CHIP-PCI met study criteria, and 766 (8.6 %) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be older (81.2 vs 77.5, p < 0.001) and frail (52.1 % vs. 27.3 %, p < 0.001). 1-year mortality was higher among patients with ADRD (OR 1.34, 95 % CI 1.14-1.57) as was 90-day major complications (OR 1.22, 95 % CI 1.03-1.43) and readmissions (OR 1.27, 95 % CI 1.07-1.50). Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.81, 95 % CI 1.48-2.22) and have lower time-at-home ratios (Mean Difference -5.48, 95 % CI -9.24 to -2.45).
CONCLUSIONS: Patients with ADRD demonstrate higher 1-year mortality as well as major complications. They demonstrate especially poor time-at-home ratio and risk for discharge to a higher level of care. These data should be used by patients, their families, and physicians to facilitate goal-concordant care.